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Chlamydophila pneumoniae (C. pneumoniae) has been suggested as a stimulator of chronic inflammation in atherosclerosis. C. pneumoniae DNA was demonstrated in aortic biopsies in 50% of patients with stable angina pectoris or acute coronary syndrome undergoing coronary artery bypass grafting. C. pneumoniae mRNA, a marker of replicating bacteria, was demonstrated in 18% of the aortic biopsies. Inflammation may have a role in the pathogenesis of thoracic aortic aneurysm, aortic dissection and aortic valve stenosis. C. pneumoniae DNA was demonstrated in aortic biopsies in 26% of thoracic aortic aneurysm patients and in 11% of aortic dissection patients undergoing thoracic surgery and in 22% of stenotic aortic heart valves from patients undergoing aortic valve replacement. No bacterial mRNA was demonstrated in these aortic biopsies, nor in the valves, suggesting that the infection has passed into a persistent state. C. pneumoniae DNA was demonstrated in peripheral blood mononuclear cells in only 5% of aortic valve stenosis patients and not in thoracic aortic aneurysm or aortic dissection patients, suggesting that the bacterium disseminated to the cardiovascular tissue long before the patient required surgery. The copper/zinc ratio in serum, a marker of infection/inflammation, was significantly elevated in thoracic aortic aneurysm patients, supporting an inflammatory pathogenesis. Patients positive for C. pneumoniae in the aortic valve had more advanced coronary atherosclerosis, further supporting a possible role for C. pneumoniae in atherosclerosis. Mice were infected with C. pneumoniae that disseminated to all organs investigated (i.e. lungs, heart, aorta, liver and spleen). Trace element concentrations were altered in infected animals with an increased copper/zinc ratio in serum, a progressively increased iron concentration in the liver and a progressively decreased iron concentration in serum. Iron is important for C. pneumoniae metabolism, and a changed iron homeostasis was noted in infected mice by alterations in iron-regulating proteins, such as DMT1 and hepcidin.

In the pre-contact era, Huron women were relatively powerful. They were active participants in the political, economic, and cultural activities of pre-contact Huronia. After contact with Europeans, however, epidemic disease swept through the Huron country. As a virgin soil population, the Hurons were devastated by contagious disease. Beginning in 1634, they witnessed epidemic outbreaks of diseases such as measles, scarlet fever, influenza, and smallpox. The epidemics had a harsh physical toll on all Hurons, particularly pregnant and breast-feeding women. The incidence of disease was high and the mortality rate was at least fifty percent. The epidemics also had cultural consequences. As a result of epidemic disease, the Hurons witnessed changes to their political processes, economic activities, cultural practices, and spiritual beliefs. Two of the most significant cultural consequences of contagious disease were warfare with the Five Nations and the loss of faith in traditional beliefs. Each of the cultural changes instigated by contagious disease affected the power and prestige of Huron women. The impact of contagious disease on Huron women was overwhelmingly negative.

In the pre-contact era, Huron women were relatively powerful. They were active participants in the political, economic, and cultural activities of pre-contact Huronia. After contact with Europeans, however, epidemic disease swept through the Huron country. As a virgin soil population, the Hurons were devastated by contagious disease. Beginning in 1634, they witnessed epidemic outbreaks of diseases such as measles, scarlet fever, influenza, and smallpox. The epidemics had a harsh physical toll on all Hurons, particularly pregnant and breast-feeding women. The incidence of disease was high and the mortality rate was at least fifty percent. The epidemics also had cultural consequences. As a result of epidemic disease, the Hurons witnessed changes to their political processes, economic activities, cultural practices, and spiritual beliefs. Two of the most significant cultural consequences of contagious disease were warfare with the Five Nations and the loss of faith in traditional beliefs. Each of the cultural changes instigated by contagious disease affected the power and prestige of Huron women. The impact of contagious disease on Huron women was overwhelmingly negative.

Non-communicable disease (NCD) (particular by cardiovascular disease, CVD) is the leading cause of death in most countries including OECD countries. WHO (World Health Organization, 2002) has emphasized the trend of disease patterns shifting from communicable diseases towards to non-communicable diseases globally. However, globalization drives economic activities vigorously and alternates work conditions, such as prolonger or irregular working time, changing patterns of job. And then, more sweating, stress and occupational safety of labors after globalization were noted by many worldwide scholars. ¡§Karoshi¡¨ (death from overwork) is a controversial issue of occupational matters in these years all over the world. According to past empirical literatures, CVD was also the major medical cause of death from overwork. Hence, we collect panel data of CVD mortality, working hours of labor and KOF index of globalization covering 19 OECD countries from a period of 1980 to 2007, and measure by panel cointegration analysis and fully modified OLS (FMOLS) to estimate the reciprocal relationship among these variables. The evidence findings show significant influence on CVD mortality if increasing working hours of labor, especially at age groups of 15 to 24 year. While significant effect on CVD mortality through by globalization was found at age group 25 to 54 year and elders, particular in social globalization.

This study was undertaken to investigate the relationship between Natural Killer cells and HLA-G at the placental barrier in HIV-I infected pregnant women and to establish the significance, if any, to in utero infection. Fifty-five HIV -I infected pregnant women were recruited into the study after consent was obtained. Blood samples were collected from both mothers and babies for viral loads and CD4+ cell counts. Placental samples were obtained from pregnancies at delivery and examined by immunoperoxidase immunohistochemistry methods using monoclonal antibodies to p24 antigens and Natural Killer (CD56+) cells. HLA-G expression was quantified using real-time polymerase chain reaction. Analysis of viral loads and CD4+ cell counts were undertaken in categories. No significant association was observed between the viral load of mothers and their CD4+ cell counts. Eighteen percent of the women in this study population had 5 log viral loads with a transmission rate of 0.27(95% Cl, 0.15 - O. 39). Maternal viraemia was significantly associated with transmission of infection to babies (p = 0.047). The odds ratio indicated that for every 1 log increase in maternal viral load the babies were 3.1 times more likely to acquire the infection (Exp (B) = 3.137 (95%CI, 1.015-9.696). Furthermore, the study found that a higher number of female babies were infected than males. Although not statistically significant the odds ratio indicated that female babies were 3.1 times more likely to become infected than males (Exp (B) = 3.110 (95%CI, 0.819-11.808). We report here the results of immunohistochemistry for p24 antigens and NK (CD56+) cells and compare them to the immunological responses of both mothers and babies at birth. HIV-1 antigens were detected in 94.5% of all placentas by immunohistochemistry. Infiltration of CD56+ was found in 98% of placental tissue. The analysis revealed that the presence of p24 antigens in placental tissue was not influenced by maternal viral load or CD4+ cell counts. Lower median NK cell values were observed in placentas of mothers with infected babies as compared with the uninfected cluster. Although not statistically significant, the risk of vertical transmission was increased 3.4 times more in placentas which had lower NK cell values. According to the odds ratio, babies CD4+ counts were affected by every 1 log increase in mother's viral load. Overall, maternal viral load emerged as a strong predictor for risk of infection from infected mothers to their infants. Our analysis indicated that female babies were 3.7 times more likely to acquire the infection than males. Using data obtained from real-time PCR we investigated the relationship between maternal viral load and the quantity of HLA-G expression (p = 0.045; 95%CI 1.029- 11.499). Logistic regression models revealed that mother's viral load was the strongest risk factor for vertical transmission. No statistically significant correlation was noted with HLA-G and viral transmission. However, the odds ratio indicated that the risk of infection increased by 1.3 with every 1 fold increase in HLA-G expression. An analysis of mother-to-child transmission rates by gender revealed that the odds ratio for transmission was 3.4 times more in female babies than in males. We then investigated the relationship between maternal viraemia and HLA-G expression. A positive correlation between maternal viral load and placental HLA-G was observed (p = 0.038). When gender susceptibility to HLA-G expression was explored a statistically significant association was observed in placental tissue of mothers with infected and uninfected male babies and HLA-G expression (p = 0.013). To conclude, the analysis found that HLA-G was up regulated 3.95 times more in placental tissue of mothers with infected babies than in mothers with uninfected babies. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

Background: Lifestyle related non-communicable diseases are now the biggest cause of death and burden of disease in Thailand. NANDA is an evidence- based classification system of nursing diagnosis. Aim: The purpose of the study was to identify and describe the nursing needs of a patient group from a low socio-economic background located in an urban primary health-care setting in Thailand by using NANDA. Method: The study is a structured observation study with a quantitative approach. The study was conducted at a health- center in Bangkok, Thailand. Result: 42 different NANDA diagnoses were identified in the observed group. In total 609 nursing diagnoses were distributed among 96 patients of which 76 were women. The most frequent nursing need diagnosis found was; Imbalanced nutrition; more than body requirement. The most frequent nursing risk diagnosis identified was: Risk for decreased cardiac tissue perfusion. Conclusion: The nursing needs observed in the patient group were mainly related to non- communicable diseases. The disease panorama observed in the patient group coherent with findings in international modern research. Significant relationships and patterns between nursing needs could be identified which strengthens the idea of using an instrument such as NANDA. In conducting the study it was evident that some nursing problems did not match with any diagnosis in the NANDA taxonomy. Clinical impact: The study shows the nursing needs among a patient group with low-socio economic backgrounds in an urban primary health care setting in Bangkok. NANDA is a good tool to systematize nursing care in the nursing profession. It can be beneficial for students in similar situations to use a tool like NANDA to categorize their assessments and impressions. / Bakgrund: Livsstil relaterade icke-smittsamma sjukdomar är numera den största dödsorsaken och sjukdomsbördan i Thailand. NANDA är en evidensbaserad klassificeringssystem av omvårdnad diagnos. Syfte: Syftet med studien var att beskriva och identifiera omvårdnadsbehov hos en patientgrupp med låg socioekonomisk bakgrund inom primärvården i Bangkok genom att använda NANDA. Metod: Studien är en strukturerad observationsstudie med en kvantitativ ansats. Studien genomfördes på en primärvårsinstans i Bangkok. Resultat: 42 olika NANDA diagnoser identifierades i den observerade gruppen. Totalt fördelades 609 diagnoser på 96 patienter, varav 76 var kvinnor. Vanligaste omvårdnadnadsdiagnosen var Obalanserad kost, mer än kroppsbehovet. Den vanligaste omvårdnads riskdiagnosen identifierad var Risk för minskad hjärtvävnads perfusion. Slutsats: Omvårdnads behovet i den observerade patient gruppen var främst relaterat till icke smittsamma livsstilsrelaterade sjukdomar. Sjukdomspanoramat i den observerade patientgruppen var i överensstämmelse med resultat i internationell modern forskning. Att använda NANDA visade sig vara använbart för att organisera och systematisera observationer och data oavsett sammanhang. Signifikanta samband och mönster mellan olika omvårdnadsbehov kunde identifieras. Ett antal identifierade omvårdnadproblem matchade inte med någon diagnos i NANDA taxonomin. Klinisk betydelse: Studien visar på omvårdnadsbehovet hos en patientgrupp med låg socioekonomisk bakgrund i en urban primärvårdsinstans i Bangkok. NANDA är ett bra verktyg för att systematisera omvårdnad i sjuksköterskeyrket. Det kan vara fördelaktigt för studenter i liknande situationer att använda ett verktyg som NANDA att kategorisera sina bedömningar och intryck.

By knowing the incidence of an infectious disease, we can ascertain the high risk factors of the disease as well as the e ectiveness of awareness programmes and treatment strategies. Since the work of Hugo Muench in 1934, many methods of estimating the force of infection have been developed, each with their own advantages and disadvantages. The objective of this thesis is to explore the di erent compartmental models of infectious diseases and establish and interpret the parameters associated with them. Seven models formulated to estimate the force of infection were discussed and applied to data obtained from CAPRISA. The data was agespeci c HIV prevalence data based on antenatal clinic attendees from the Vulindlela district in KwaZulu-Natal. The link between the survivor function, the prevalence and the force of infection was demonstrated and generalized linear model methodology was used i to estimate the force of infection. Parametric and nonparametric force of infection models were used to t the models to data from 2009 to 2010. The best tting model was determined and thereafter applied to data from 2002 to 2010. The occurring trends of HIV incidence and prevalence were then evaluated. It should be noted that the sample size for the year 2002 was considerably smaller than that of the following years. This resulted in slightly inaccurate estimates for the year 2002. Despite the general increase in HIV prevalence (from 54.07% in 2003 to 61.33% in 2010), the rate of new HIV infections was found to be decreasing. The results also showed that the age at which the force of infection peaked for each year increased from 16.5 years in 2003 to 18 years in 2010. Farrington's two parameter model for estimating the force of HIV infection was shown to be the most useful. The results obtained emphasised the importance of HIV awareness campaigns being targeted at the 15 to 19 year old age group. The results also suggest that using only prevalence as a measure of disease can be misleading and should rather be used in conjunction with incidence estimates to determine the success of intervention and control strategies. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

In spite of the remarkable development of modern medical treatment and technology, the threat of pandemic diseases such as anthrax, cholera, and SARS has not disappeared. As a part of emerging healthcare decision problems, many researchers have studied how to detect and contain disease outbreaks, and our research is aligned with this trend. This thesis mainly consists of two parts: epidemic simulation modeling for effective intervention strategies and spatiotemporal monitoring for outbreak detection. We developed a stochastic epidemic simulation model of a pandemic influenza virus (H1N1) to test possible interventions within a structured population. The possible interventions — such as vaccination, antiviral treatment, household prophylaxis, school closure and social distancing — are investigated in a large number of scenarios, including delays in vaccine delivery and low and moderate efficacy of the vaccine. Since timely and accurate detection of a disease outbreak is crucial in terms of preparation for emergencies in healthcare and biosurveillance, we suggest two spatiotemporal monitoring charts, namely, the SMCUSUM and RMCUSUM charts, to detect increases in the rate or count of disease incidents. Our research includes convenient methods to approximate the control limits of the charts. An analytical control limit approximation method for the SMCUSUM chart performs well under certain conditions on the data distribution and monitoring range. Another control limit approximation method for the RMCUSUM chart provides robust performance to various monitoring range, spatial correlation structures, and data distributions without intensive modeling of the underlying process.